Typhus (rickettsial infections)
Typhus is not one disease but a group of infections caused by rickettsiae, very small bacteria that live inside cells.
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Medicines commonly prescribed for Typhus (rickettsial infections)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 100 mgActive substance: doxycyclineManufacturer: Laboratorio Reig Jofre, S.A.Prescription requiredDosage form: CAPSULE, 200 mgActive substance: doxycyclineManufacturer: Industrial Farmaceutica Cantabria S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 60 mlActive substance: doxycyclineManufacturer: Hospira Invicta S.A.Prescription required
Typhus is not one disease but a group of infections caused by rickettsiae, very small bacteria that live inside cells. They do not reach a person in water or food but through a bite: a louse, a flea, a tick or a mite larva. Everything starts abruptly — a high fever and a brutal headache — and a few days later a rash appears. The illness can be severe, yet it responds well to an antibiotic if that is started in time; the whole problem is getting the doctor to suspect it in time.
A fork in the road first, so that you do not read the wrong page. If there were no bites and it all began after a trip with dubious water and food, with a fever that climbed day after day, what you most likely want is typhoid fever: a different infection, caused by a salmonella and spread by dirty water and food. The names resemble each other for historical reasons, but the two diseases have nothing in common.
What is called typhus
The varieties differ in the creature that carries them and in where they are picked up, but they behave alike and are treated alike.
- Epidemic typhus, the most severe. It is carried by the body louse — the one that lives in the seams of clothing, not in the hair. It appears where people live crowded together and cannot wash themselves or their clothes regularly: refugee camps, prisons, wars and disasters, people without housing. One important detail: the bite itself does not infect. The louse's droppings do, rubbed into the wound when the person scratches.
- Murine, or endemic, typhus, carried by the fleas of rats and cats. It occurs in warm climates and in port cities, the Mediterranean coasts included, and usually runs a milder course.
- Scrub typhus, carried by mite larvae — tiny creatures that latch on in long grass and undergrowth. It belongs to the Asia-Pacific region.
- Tick-borne spotted fevers, close relatives carried by ticks. The one that matters most to our readers is Mediterranean spotted fever, found in Spain, Italy, Portugal and southern France, usually in summer and often after contact with a dog that was carrying a tick.
Between the bite and the first signs there are usually a few days to two weeks.
Who is at risk, and where
- travel to Africa, South and South-East Asia and Central and South America, particularly to rural areas and with nights in simple accommodation;
- walking through long grass, scrub and pasture; field work, hunting, hiking;
- contact with dogs and cats that may carry ticks and fleas;
- living or working where there are a lot of rodents;
- crowding and no way to wash or change clothes regularly — hostels, shelters, camps, disaster zones;
- lice in the household: if body lice turn up on one person, everyone around them is at risk.
In wealthy countries epidemic typhus is a rarity today, but it has not gone away: it comes back whenever ordinary daily life collapses.
What it looks like
The onset is usually sudden, over a matter of hours.
- A high fever of 39–40 °C, with chills, and it stays up.
- A very severe headache — the most characteristic complaint of all, described as unbearable and not relieved by ordinary painkillers.
- Aching muscles and joints, marked weakness, nausea and sometimes vomiting, discomfort in bright light, a dry cough.
- A rash. It appears on the third to fifth day of illness, usually starting on the trunk and spreading out towards the arms and legs. At first these are pink spots that blanch under pressure; later they may darken and stop blanching. On brown and black skin the rash is harder to see, so it is worth looking in good light, including on the abdomen and the sides of the chest.
- An eschar at the site of the bite — a dark, almost black scab the size of a coin, with a red ring around it. It neither hurts nor itches, which is why people almost never find it themselves. For a doctor, though, it is an extremely strong clue and it speeds the diagnosis up enormously.
So check yourself over and show the doctor whatever you find. The eschar hides where nobody looks: in the hair and behind the ears, in the armpits, the groin, under the breast, in the crease under the buttock, behind the knee, between the toes, under the elastic of underwear. And do say where you have been in the past fortnight, whether there were any bites, whether you walked through grass, and whether there is a dog or cat at home. Without that sentence the diagnosis is nearly always made later than it should be.
When urgent help is needed
Severe illness develops fast, within a few days, and almost always where treatment has been delayed. Call an ambulance (in Europe the single number is 112) if, alongside the fever, there is:
- a rash that does not fade under pressure — if you press a clear glass against it and the spots remain visible, that is a sign of damage to the blood vessels;
- confusion, delirium, strange behaviour, seizures, heavy drowsiness;
- sudden breathlessness, bluish lips;
- falling blood pressure: cold clammy skin, a fast weak pulse, vision going dark on trying to stand;
- a markedly stiff neck and inability to tolerate light;
- almost no urine for many hours together;
- darkening or blackening of the skin on the fingers, the tips of the ears or the nose.
Do not wait until morning and do not try to "bring the fever down and see". In every other case, when a fever with a severe headache follows a bite or a trip, you should see a doctor the same day.
Why treatment starts before the tests come back
This is the single most important feature of the disease and it is worth understanding in advance. Tests for rickettsial infection almost always lag behind: antibodies appear in the blood only after one or two weeks, and the diagnosis is often confirmed on the second, convalescent sample — that is, once the person has either recovered or not. Faster methods exist, but not everywhere and not always.
The antibiotic is therefore prescribed on the clinical picture: fever plus a severe headache plus a rash plus fitting circumstances — a bite, a trip, lice — is reason enough to start treatment today. Every day of delay measurably worsens the outcome, whereas an early start turns a dangerous illness into something that clears within a week.
Treatment is with a drug of the tetracycline class, and the choice is the same for adults and for children. What is worth knowing about it:
- improvement comes quickly — the fever usually falls within a day or two. If nothing changes in 48 to 72 hours, the diagnosis is reconsidered;
- the course is finished in full, even once you feel well;
- the everyday antibiotics prescribed for tonsillitis or bronchitis do not work here: rickettsiae are not sensitive to them;
- choosing the drug yourself is not an option, both because a specific class is required and because a similar picture can be malaria or meningococcal infection, where the treatment is entirely different;
- severe cases are treated in hospital.
How to protect yourself
There is no vaccine against typhus, so protection means avoiding bites and keeping to ordinary hygiene.
- put a repellent containing DEET or icaridin on the skin and reapply it as the label says;
- in grass and scrub wear a long-sleeved shirt and trousers, tuck the trouser legs into your socks, and choose light-coloured clothing, on which a tick shows up;
- clothing and hiking gear can be treated with a permethrin-based product; it is not applied to skin;
- do not sit or lie directly on the grass;
- after every outing into the countryside, check your whole body — head and hairline, behind the ears, neck, armpits, groin, the waistband area, behind the knees, between the toes. Children are checked by an adult. A shower the same day helps wash off any that have not yet attached;
- if you find a tick, take it off at once with tweezers, gripping as close to the skin as you can and pulling straight up, without twisting it or smearing anything on it;
- treat dogs and cats against fleas and ticks, and do not let them sleep in the bed after running through grass;
- keep rodents down in and around the house.
Where there are lice, what matters is not the body but the clothes: the body louse lives in the seams of garments and bedding, not on the person. Everything washable is washed hot and dried at a high temperature or ironed with attention to the seams; whatever cannot be washed goes into a tightly closed bag for several weeks. Wash and change clothes as often as possible, treat everyone living in the household, and do not crush lice against the skin or scratch bites open — that is exactly how the infection gets in.
Recovery, and what can follow
With treatment started in time, most people recover completely and without after-effects. Following a severe episode, weakness, headaches and difficulty concentrating can last several more weeks; that is expected and it gradually passes.
There is one feature few people know about. After epidemic typhus, the organism can lie quietly in the body for years and one day produce a return of the illness, usually in a milder form, at a time of heavy stress, serious illness or old age. In itself this is not dangerous, but such a person is once again infectious to lice, so where lice are present a fresh outbreak can begin with them. If you ever had typhus, therefore, tell the doctor about it whenever you have an unexplained fever with a rash, even if it was decades ago.
Online consultation
In an online consultation the doctor goes through your situation properly: where you have been, what bit you, when the fever started and how the rash has changed. They help you find and describe the eschar, tell you what part of this needs to be seen in person today and what can be watched, and explain which tests make sense and why their result should not be waited for before treatment begins. They read any results you already have and go over the prescribed regimen and how to take it. Before a trip, they help you put together bite protection suited to your particular route and season.
This material is for information only and does not replace medical advice.
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